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Study Shows Antipsychotics Prescribed to Substantial Minority of Veterans with PTSD without Bipolar Disorder or Schizophrenia


BACKGROUND:
Antipsychotic medications have been increasingly prescribed for a variety of non-psychosis-related mental health problems including PTSD, which has steadily increased in prevalence among Veterans in the VA healthcare system. In FY07, 19% of VA patients diagnosed with PTSD were prescribed antipsychotics without an FDA-approved indication. Moreover, a VA multi-site randomized trial recently demonstrated no advantage from the adjunctive use of the atypical antipsychotic risperidone over placebo for antidepressant-resistant PTSD. Given limited knowledge about the use of antipsychotics in Veterans with PTSD returning from Iraq and Afghanistan, this study examined the rates of antipsychotic use in this patient population, as well as correlations with sociodemographics, military service, and psychiatric factors. The primary outcome was medication prescription status classified as: 1) no psychiatric prescriptions, 2) prescription for psychiatric medications other than antipsychotics, and 3) prescription for antipsychotic medication, including atypical antipsychotics. Using VA data, investigators identified 186,460 Veterans with a diagnosis of PTSD who received VA care between 1/07 and 9/11 – and were followed through 9/12. Veterans with a comorbid diagnosis of schizophrenia and bipolar disorder were excluded.

FINDINGS:

  • Antipsychotics were prescribed to a substantial minority of OEF/OIF/OND Veterans with PTSD who did not also have a diagnosis of bipolar disorder or schizophrenia. Of the 186,460 Veterans in this study, 37,125 (20%) received no psychiatric medications, 114,052 (61%) received psychiatric mediations other than antipsychotics, and 35,283 (19%) received antipsychotics.
  • Of those Veterans receiving antipsychotics, 1% received typical (i.e., haloperidol) and 96% received atypical medications (i.e., aripiprazole, clozapine), while 2% received both.
  • Male Veterans and those in the Army, of lower rank, and with active duty status (vs. National Guard/Reserve) were more likely to be prescribed antipsychotics. Comorbid psychiatric conditions, particularly substance use and personality disorders, as well as suicidal ideation also were associated with greater use of antipsychotics compared to other types of psychiatric medications.
  • Antipsychotics were prescribed much later after the date of PTSD diagnosis than other psychiatric medications, suggesting they were not first-line medications.

IMPLICATIONS:

  • Given limited evidence of the benefit of antipsychotics for PTSD and their potential adverse metabolic side effects, authors suggest that clinicians carefully weigh the risks and benefits of antipsychotic use in Veterans with PTSD.

LIMITATIONS:

  • This study relied on administrative data, thus findings are based on diagnostic coding from clinical records and not clinical interviews.
  • Investigators could not determine whether antipsychotic or psychiatric medication was specifically prescribed for PTSD – or identify which specific PTSD symptoms were being targeted.


PubMed Logo Cohen B, Shi Y, Neylan T, Maguen S, and Seal K. Antipsychotic Prescriptions in Iraq and Afghanistan Veterans with Posttraumatic Stress Disorder in Department of Veterans Affairs Healthcare, 2007-2012. Journal of Clinical Psychiatry. March 3, 2015, e-pub ahead of print.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.